title: Prophylaxis and treatment of anthrax in pregnant women.
abstract: OBJECTIVE
  To review the safety and pharmacokinetics of antimicrobials recommended for anthrax postexposure prophylaxis and treatment in pregnant women.
  
  
  METHODS
  Articles were identified in the PubMed database from inception through December 2012 by searching the keywords (["pregnancy]" and [generic antibiotic drug name]). Additionally, we searched clinicaltrials.gov and conducted hand searches of references from REPROTOX, TERIS, review articles, and Briggs' Drugs in Pregnancy and Lactation.
  
  
  METHODS
  Articles included in the review contain primary data related to the safety and pharmacokinetics among pregnant women of 14 antimicrobials recommended for anthrax postexposure prophylaxis and treatment (amoxicillin, ampicillin, chloramphenicol, clindamycin, ciprofloxacin, doripenem, doxycycline, levofloxacin, linezolid, meropenem, moxifloxacin, penicillin, rifampin, and vancomycin).
  
  
  RESULTS
  The PubMed search identified 3,850 articles for review. Reference hand searching yielded nine additional articles. In total, 112 articles met the inclusion criteria.
  
  
  CONCLUSIONS
  Overall, safety and pharmacokinetic information is limited for these antimicrobials. Although small increases in risks for certain anomalies have been observed with some antimicrobials recommended for prophylaxis and treatment of anthrax, the absolute risk of these antimicrobials appears low. Given the high morbidity and mortality associated with anthrax, antimicrobials should be dosed appropriately to ensure that antibiotic levels can be achieved and sustained. Dosing adjustments may be necessary for the β-lactam antimicrobials and the fluoroquinolones to achieve therapeutic levels in pregnant women. Data indicate that the β-lactam antimicrobials, the fluoroquinolones, and, to a lesser extent, clindamycin enter the fetal compartment, an important consideration in the treatment of anthrax, because these antimicrobials may provide additional fetal benefit in the second and third trimesters of pregnancy.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia; and the Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Infectious Diseases and Obstetric Specialties, Magee-Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Dana
authors.initials: D
authors.lastname: Meaney-Delman
authors.forename: Sonja A
authors.initials: SA
authors.lastname: Rasmussen
authors.forename: Richard H
authors.initials: RH
authors.lastname: Beigi
authors.forename: Marianne E
authors.initials: ME
authors.lastname: Zotti
authors.forename: Yalonda
authors.initials: Y
authors.lastname: Hutchings
authors.forename: William A
authors.initials: WA
authors.lastname: Bower
authors.forename: Tracee A
authors.initials: TA
authors.lastname: Treadwell
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology*; D000881:Anthrax / Q000517:prevention & control*; D000890:Anti-Infective Agents / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000139:chemically induced*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011297:Prenatal Exposure Delayed Effects
chemical_list: D000890:Anti-Infective Agents